Artwork by Monica Garwood for Anxy magazine

Today, I finished the first complete draft of my Master’s thesis, and what I hope will become my first published article as a scientist. Today, I had an anxiety attack, ending up on the floor of a university bathroom hyperventilating and sobbing.

These events paint a painfully accurate picture of a 22-year-old with obsessive-compulsive disorder and type I bipolar disorder. I’ve been depressed since the age of 12, suicidal and self-harming since 13, and entirely defeated by my early college years. Yet, somehow, I’m alive and exactly where I need to be today.

I could tell you about believing in yourself, perseverance, or self-care. But I’m not here today because of those things on their own. I’m here because of TREATMENT.

- Kaedan O as told to Bring Change to Mind

It is shocking to learn that more than half, 57%, of adults with a mental illness in the U.S. receive no treatment for their condition. And for youth, the situation is even worse: 59% of youth with major depression do not receive any mental health treatment. Often, people will wait years to seek treatment. Left untreated, mental illness or symptoms of mental trauma can worsen, resulting in diminishing ability to function in day-to-day activities. It may lead to individual and societal level challenges including homelessness, involvement in the criminal justice system, victimization, and suicidality. 

“The human, social and economic impact of not treating serious mental illness is beyond calculation.”

elizabeth Hancq,
TREATMENT ADVOCACY CENTER

 

So if we know that treatment helps, and a lack of treatment leads to long term consequences for both the individual and society at large, WHY aren’t people getting treatment in a timely manner?

Lack of Qualified, Trained Professionals

Availability of care is a critical challenge. Shortages of emergency psychiatric facilities can mean that even those experiencing a crisis may have to wait days or weeks for care. There is also a nationwide shortage of mental health professionals, especially child and adolescent psychiatrists: there are only 8,300 child psychiatrists in the U.S. Therapists who represent the cultural diversity of our communities are in short supply. Cultural competence is an important factor for effective treatment and this leaves many without professionals to whom they can relate. In rural areas, these access issues are amplified.

Cost Barriers

Many struggle to get their insurance to cover their mental health treatment, despite two recent federal laws aimed at bringing parity between mental and physical health coverage. Serious disparities remain and, “often insurance will only pay enough to stabilize a patient's condition, but not enough to improve their underlying illness.” On top of that, only 55% of psychiatrists accept private insurance and even fewer accept Medicare or Medicaid. And then there are the 4.7 million American adults who suffer from a mental illness and remain uninsured. 

Stigma

Even having insurance and professionals available in your area may not be enough to access treatment. Stigma often prevents people from help-seeking behaviors. The good news is that improving access can also reduce stigma. In states that have more resources allocated for mental health services, adults had more positive attitudes regarding the effectiveness of treatment, were more willing to seek treatment, and were more likely to perceive that others were caring and sympathetic to people with mental illness.

Battery Powered is interested in changing the standard for when and how people can access care, believing the earlier and more local, the better. Currently, many individuals only get treatment when they are dangerous to themselves or others. We want people to be able to access care much earlier and interrupt the individual and societal fallout of untreated mental illness. We are particularly interested in programs that increase equity of access and provide culturally relevant care.  

Community-Based Models. Community-based services, including Family Resource Centers, include therapy, coaching, and parenting education. They are typically deeply embedded into the communities they serve and thus can offer the most culturally appropriate support and contribute to ease of access. A relatively new designation, the Certified Community Behavioral Health Clinic, is an enhanced one-stop-shop offering a comprehensive array of services, with standards to foster continuity and coordination. 

Importantly, activities that build social capital and cohesion are part of supporting mental health. Community-based models often offer activities that may not, on the surface, look like mental health support but have the effect of creating social cohesion, purpose, and agency which can reduce isolation, anxiety, and depression. 

Image courtesy of Instituto Familiar de la Raza                       

Peer Support. There are few things as impactful as having someone say, “I know how you feel because I was there too. And I know that you can get better because I got better.” Peer support in therapeutic settings increases hope. It has also proven effective. Involving people with lived experience has shown positive impacts on those exiting the mental health system, including lower repeat hospital admissions, an increase in independent living, greater adherence to treatment, and improved self-empowerment. 

Peer counselors are certified professionals who support their peer’s recovery. They are an important part of filling the gap in availability of trained mental health professionals.

Telehealth and Technology. Telehealth is a promising model that provides therapy and other services through live video streaming over the Web or by phone. These programs are a response to changes in communication preferences, improved technology, and limited access to therapeutic professionals in many areas. Furthermore, they may help alleviate the impact of stigma because people can meet with a mental health practitioner online and from home. 

Research for Effective Therapies.  There is still a lot to learn about the human brain. Innovations and research can unlock our potential for understanding the brain and improving mental health. Research into new and effective therapies is critical. Some examples of particular interest include:

• Psychedelics –Current research is reviving a body of research that was robust in the 1940-60s until psychedelics were made illegal under the Controlled Substances Act. There is mounting evidence supporting it as a promising therapy for treatment-resistant post-traumatic stress, end of life depression/anxiety, and even addiction.
• Biological markers – There are many instances where patients are under- or over-diagnosed because there are no specific tests that can aid in diagnostics. Molecular biomarkers may assist in making earlier and clearer diagnosis. This research is critically important to better understanding mental health in children.